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ZWR - Das Deutsche Zahnärzteblatt 2008; 117(7/08): 361-368
DOI: 10.1055/s-0028-1085941
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Chirurgie
© Georg Thieme Verlag Stuttgart · New York

Sedierungen in der Oralchirurgie – Teil 1: Pharmakologische und klinische Aspekte intravenöser Sedativa

Intravenous Sedation for Oral SurgeryA. Yazici, M. Kreisler
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Publication History

Publication Date:
18 August 2008 (online)

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Obwohl moderne Verfahren der Lokalanästhesie heute eine schmerzfreie Behandlung ermöglichen, bleiben viele Patienten gegenüber zahnärztlichen und insbesondere oralchirurgischen Prozeduren ängstlich eingestellt. Die Angst dieser Patienten kann eine unzureichende Kooperation und somit eine Erschwerung oder einen Abbruch der Behandlung zur Folge habe. In ausgeprägten Fällen kann die Angst sogar zur Ablehnung oder Vermeidung der notwendigen Therapie führen. Dies gilt umso mehr für umfangreichere Eingriffe, wie die operative Entfernung von Weisheitszähnen oder die Behandlung von ängstlichen Kindern. Im folgenden 1. Teil des Beitrags werden pharmakologische und klinische Aspekte moderner Sedativa dargestellt und klinisch evaluiert. Insbesondere wird auf die praktische Vorgehensweise bei der intravenösen Sedierung oralchirurgischer Patienten eingegangen und verschiedene intravenöse Sedativa miteinander verglichen.

Despite modern local anaesthesia procedures allowing a painless treatment, many patients remain fearful towards dental procedures. This is in particular true for treatments in the field of oral surgery, as the removal of wisdom teeth as well as for the treatment of children. For these patients, intravenous sedation may present an alternative treatment option to local or general anaesthesia. The aim of this article is an evidence–based evaluation of sedation procedures with regard to their application in dentistry and oral surgery. The first part of the article considers clinical, pharmacological and practical aspects of intravenous sedatives.

Schlüsselwörter:

Oralchirurgie - Analgosedierung - Conscious Sedation - Midazolam

Key Words

Oral surgery - Sedation - Conscious Sedation - Midazolam

Literatur

  • 1 Abrams R, Morrison JE, Villasenor A. et al. . Safety and Effectivness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric procedures.  Anesth Prog. 1993;  40 63-66
    PubMedGoogle Scholar
  • 2 Amrein R, Hetzel W.. Pharmacology of Dormicum® (midazolam) and Anexate® (flumazenil).  Acta Anaesthesiol Scand. 1990;  92 6-11
    PubMedGoogle Scholar
  • 3 Arcos JA.. Midazolam–induced ventricular irritability.  Anesthesiology. 1987;  67 612
    PubMedGoogle Scholar
  • 4 Arzneimittelkommission der deutschen Ärzteschaft. Schwere unerwünschte Arzneimittelwirkungen nach Propofol–Infusion zur Sedierung.  Deutsches Ärzteblatt. 2004;  101 2911
    PubMedGoogle Scholar
  • 5 Aun C, Flynn PJ, Obst D.. A comparison of midazolam and diazepam for intravenous sedation in dentistry.  Anaesthesia. 1984;  39 589-593
    CrossrefPubMedGoogle Scholar
  • 6 Barclay JK, Hunter KM, McMillan W.. Midazolam and diazepam compared as sedatives for outpatient surgery under local analgesia.  Oral Surg Oral Med Oral Pathol. 1985;  59 349-355
    CrossrefPubMedGoogle Scholar
  • 7 Barkin ME, Middleton RA.. ECG monitoring of oral surgery patients receiving local anesthetic.  J Oral Surg. 1978;  36 779-783
    PubMedGoogle Scholar
  • 8 Bell GW, Kelly PJ.. A study of anxiety, and midazolam–induced amnesia in patients having lower third molar teeth extracted.  Br J Oral Maxillofac Surg. 2000;  38 596-602
    CrossrefPubMedGoogle Scholar
  • 9 Brandt L.. Inhalationsanästhesie. In: Brandt L. (Hrsg). Illustrierte Geschichte der Anästhesie. Stuttgart: Wissenschaftliche Verlagsgesellschaft mbH Stuttgart 1997: 59-90
    Google Scholar
  • 10 Campbell RL, Smith PB.. Intravenous sedation in 200 geriatric patients undergoing office oral surgery.  Anesth Prog. 1997;  44 64-67
    PubMedGoogle Scholar
  • 11 Chernik DA, Gillings D, Laine H. et al. . Validity and reliability of the Observer's Assessment of Alertness/Sedation scale: Study with intravenous midazolam.  J Clin Psychopharmacol. 1990;  10 244-251
    PubMedGoogle Scholar
  • 12 Church JA, Pollock JSS, Parbrook GD.. Comparison of two techniques for sedation in dental surgery.  Anaesthesia. 1991;  46 780-783
    CrossrefPubMedGoogle Scholar
  • 13 Clark MS, Silverstone LM, Coke JM. et al. . Midazolam, diazepam, and placebo as intravenous sedatives for dental surgery.  Oral Surg Oral Med Oral Pathol. 1987;  63 127-131
    CrossrefPubMedGoogle Scholar
  • 14 Clark RN, Rodrigo MR.. A comparative study of intravenous diazepam and midazolam for oral surgery.  J Oral Maxillofac Surg. 1986;  44 860-863
    CrossrefPubMedGoogle Scholar
  • 15 Croughwell N, Reves JG, Hawkins E.. Cardiovascular changes after midazolam in patients with aortic stenosis.  Anesth Analg. 1988;  67 1-6
    PubMedGoogle Scholar
  • 16 de Jong RH, Bonin JD.. Benzodiazepines protect mice from local anesthetic convulsions and deaths.  Anesth Analg. 1981;  60 385-389
    PubMedGoogle Scholar
  • 17 Department of Health. A Conscious Decision. . A Review of the Use of General Anaesthesia and Sedation in Primary Dental Care.  London: Department of Health 2000
    Google Scholar
  • 18 D'Eramo EM, Bookless SJ, Howard JB.. Adverse events with outpatient anesthesia in Massachusetts.  J Oral Maxillofac Surg. 2003;  61 793-800
    CrossrefPubMedGoogle Scholar
  • 19 Dionne RA, Yagiela JA, Moore PA. et al. . Comparing efficacy and safety of four intravenous regimens in dental outpatients.  J Am Dent Assoc. 2001;  132 740-751
    PubMedGoogle Scholar
  • 20 Esen E, Üstün Y, Balcioglu YO. et al. . Evaluation of patient–controlled remifentanil application in third molar surgery.  J Oral Maxillofac Surg. 2005;  63 457-463
    CrossrefPubMedGoogle Scholar
  • 21 Fong CC, Kwan A.. Patient controlled sedation using remifentanil for third molar surgery.  Anaesth Intensive Care. 2005;  33 73-77
    PubMedGoogle Scholar
  • 22 Garip H, Gürkan Y, Toker K. et al. . A comparison of midazolam and midazolam with remifentanil for patient–controlled sedation during operations on third molars.  Br J Oral Maxillofac Surg. 2006;  45 212-216
    PubMedGoogle Scholar
  • 23 Ganzberg S, Pape RA, Beck FM.. Remifentanil for use during conscious sedation in outpatient oral surgery.  J Oral Maxillofac Surg. 2002;  60 244-250
    CrossrefPubMedGoogle Scholar
  • 24 Ghouri AF, Ramirez MA, White PF.. Effect of flumazenil on recovery after midazolam and propofol sedation.  Anesthesiology. 1994;  81 333-339
    CrossrefPubMedGoogle Scholar
  • 25 Girdler NM, Fairbrother KJ, Lyne JP. et al. .A randomised crossover trial of post–operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period. Br Dent J 2002: 335-339
    Google Scholar
  • 26 Girdler NM, Lyne JP, Wallace R. et al. .A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil. Anaesthesia 2002b 57: 868-876
    Google Scholar
  • 27 Girdler NM, Rynn D, Lyne JP. et al. . A prospective randomised controlled study of patient–controlled propofol sedation in phobic dental patients.  Anaesthesia. 2000;  55 327-333
    CrossrefPubMedGoogle Scholar
  • 28 Haefely W.. The preclinical pharmacology of flumazenil.  European Journal of Anaesthesiology. 1988;  2 25-28
    PubMedGoogle Scholar
  • 29 Hoke JF, Shlugman D, Dershwitz M.. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers.  Anesthesiology. 1997;  87
    PubMedGoogle Scholar
  • 30 Holderness MC, Chase PE, Dripps RD.. A narcotic analgesic and a butyrophenone with nitrous oxide for general anesthesia.  Anesthesiology. 1963;  24 336-343
    PubMedGoogle Scholar
  • 31 Hosey MT, Makin A, Jones RM. et al. . Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit.  Int J Paediatr Dent. 2004;  14 2-8
    CrossrefPubMedGoogle Scholar
  • 32 Hunter KM, Zacharias M, Parkinson R. et al. . Effect of flumazenil on the recovery from intravenous midazolam.  N Z Dent J. 1994;  90 9-12
    PubMedGoogle Scholar
  • 33 Jung M, Hofmann C, Kiesslich R. et al. . Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam.  Endoscopy. 2000;  32 233-238
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Kay B, Rolly G.. ICI 35 868, a new intravenous induction agent.  Acta Anaesthesiolog Belg. 1977;  28 303-310
    PubMedGoogle Scholar
  • 35 Liu J, Singh H, White PF.. Electroencephalogram bispectral analysis predicts the depth of midazolam–induced sedation.  Anesthesiology. 1996;  84 64-69
    CrossrefPubMedGoogle Scholar
  • 36 Luyk NH, Zacharias M, Wanwimolaruk S.. Bolus dose with continuous infusion of midazolam as sedation for outpatient surgery.  Int J Oral Maxillofac Surg. 1992;  21 172-175
    CrossrefPubMedGoogle Scholar
  • 37 MacCormac C, Kinirons M.. Reasons for referral of children to a general anaesthetic service in Northern Ireland.  Int J Paediatr Dent. 1998;  4 233-237
    PubMedGoogle Scholar
  • 38 Matthews RW, Malkawi Z, Griffiths MJ. et al. . Pulse oximetry during minor oral surgery with and without intravenous sedation.  Oral Surg Oral Med Oral Pathol. 1992;  74 537-543
    CrossrefPubMedGoogle Scholar
  • 39 Moore PA, Finder RL, Jackson DL.. Multidrug intravenous sedation – determinants of the sedative dose of midazolam.  Oral Surg Oral Med Oral Pathol. 1997;  84 5-10
    PubMedGoogle Scholar
  • 40 Mould DR, DeFeo TM, Reele S.. Simultaneous modelling of the pharmacokinetics and pharmacodynamics of Midazolam and Diazepam.  Clin Pharmacol Ther. 1995;  58 35-42
    CrossrefPubMedGoogle Scholar
  • 41 Nadin G, Coulthard P.. Memory and midazolam conscious sedation.  Br Dent J. 1997;  183 399-407
    PubMedGoogle Scholar
  • 42 National Institutes of Health Consensus Development Conference Statement.  Washington: National Institutes of Health . 1985;  5 1-6
    PubMedGoogle Scholar
  • 43 Newman LH, McDonald JC, Wallace PGM. et al. . Propofol infusion for sedation in intensive care.  Anaesthesia. 1987;  42 929-937
    CrossrefPubMedGoogle Scholar
  • 44 Ochs MW, Tucker MR, Owsley TG. et al. . The effectiveness of flumazenil in reversing the sedation and amnesia produced by intravenous midazolam.  J Oral Maxillofac Surg. 1990;  48 240-245
    CrossrefPubMedGoogle Scholar
  • 45 Ochs MW, Tucker MR, White RP.. A comparison of amnesia in outpatients sedated with midazolam or diazepam alone or in combination with fentanyl during oral surgery.  J Am Dent Assoc. 1986;  113 894-897
    PubMedGoogle Scholar
  • 46 Oei–Lim LB, Vermeulen–Cranch DME, Bouvy–Berends ECM.. Conscious sedation with propofol in dentistry. Br Dent J 170: 340-342
    Google Scholar
  • 47 Parke TJ, Stevens JE, Rice ASC.. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: Five case reports.  Br Med J. 1992;  305 613-620
    CrossrefPubMedGoogle Scholar
  • 48 Parworth LP, Frost DE, Zuniga JR. et al. . Propofol and fentanyl compared with midazolam and fentanyl during third molar surgery.  J Oral Maxillofac Surg. 1998;  56 447-453
    CrossrefPubMedGoogle Scholar
  • 49 Paterson SA, Tahmassebi JF.. Paediatric dentistry in the new millennium: 3. Use of inhalational sedation in paediatric dentistry.  Dental Update. 2003;  30 350-358
    PubMedGoogle Scholar
  • 50 Philip BK, Simpson TH, Hauch MA. et al. . Flumazenil reverses sedation after midazolam–induced general anesthesia in ambulatory surgery patients.  Anesth Analg. 1990;  71 371-376
    PubMedGoogle Scholar
  • 51 Reimann FM, Samson U, Derad I. et al. . Synergistic sedation with low–dose midazolam and propofol for colonoscopies.  Endoscopy. 2000;  32 239-244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Reves JG, Fragen RJ, Vinik HR. et al. . Midazolam: Pharmacology and uses.  Anesthesiology. 1985;  62 310-324
    CrossrefPubMedGoogle Scholar
  • 53 Richards A, Scully C.. Wide variation in patient response to midazolam sedation for outpatient oral surgery.  Oral Surg Oral Med Oral Pathol. 1993;  76 408-411
    CrossrefPubMedGoogle Scholar
  • 54 Rodrigo MRC, Fung SC.. Comparison of two techniques of patient–controlled sedation with midazolam.  Br J Oral Maxillofac Surg. 1999;  37 472-476
    CrossrefPubMedGoogle Scholar
  • 55 Rodrigo MRC, Irwin MG, Yan BSW. et al. . Patient–controlled sedation with propofol in minor oral surgery.  J Oral Maxillofac Surg. 2004;  62 52-56
    PubMedGoogle Scholar
  • 56 Rodrigo MRC, Rosenquist JB.. Effect of conscious sedation with midazolam on oxygen saturation.  J Oral Maxillofac Surg. 1988;  46 746-750
    CrossrefPubMedGoogle Scholar
  • 57 Rodrigo MRC, Rosenquist JB, Cheng CH.. Cardiac dysrhythmias with midazolam sedation.  Anesth Prog. 1990;  37 20-23
    PubMedGoogle Scholar
  • 58 Rodrigo MRC, Tong CKA.. A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery.  Anaesthesia. 1994;  49 241-244
    PubMedGoogle Scholar
  • 59 Roelofse JA, van der Bijl P.. Cardiac dysrhythmias associated with intravenous lorazepam, diazepam, and midazolam during oral surgery.  J Oral Maxillofac Surg. 1994;  52 247-250
    CrossrefPubMedGoogle Scholar
  • 60 Rudkin GE, Osborne GA, Finn BP. et al. . Intra–operative patient–controlled seation – comparison of patient–controlled propofol with patient–controlled midazolam.  Anaesthesia. 1992;  47 376-381
    CrossrefPubMedGoogle Scholar
  • 61 Runes J, Strom C.. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases.  Swed Dent J. 1996;  20 29-33
    PubMedGoogle Scholar
  • 62 Scottish Intercollegiate Guidelines Network. .Safe Sedation of Children Undergoing Diagnostic and Therapeutic Procedures. A National Clinical Guideline. Edinburgh: NHS Scotland 2002
    Google Scholar
  • 63 Stephens AJ, Sapsford DJ, Curzon MEJ.. Intravenous sedation for handicapped dental patients: a clinical trial of midazolam and propofol.  Br Dent J. 1993;  175 20-25
    PubMedGoogle Scholar
  • 64 Thomson PJ, Coulthard P, Snowdon AT. et al. . Recovery from intravenous sedation with midazolam – the value of flumazenil.  Br J Oral Maxillofac Surg. 1993;  31 101-103
    CrossrefPubMedGoogle Scholar
  • 65 Urban BJ, Amaha K, Steen SN.. Investigation of 1–4–benzodiazepine derivates as basal anesthetic agents.  Anesth Analg. 1966;  45 733-738
    PubMedGoogle Scholar
  • 66 Vandam LD.. History of anesthetic practice. In: Miller RD (Hrsg). Anesthesia, 5. Aufl. Philadelphia: Churchill Livingstone 2000: 1-4
    Google Scholar
  • 67 van der Bijl P, Roelofse JA, Joubert JJ. et al. . Intravenous midazolam in oral surgery.  Int J Oral Maxillofac Surg. 1987;  16 325-332
    CrossrefPubMedGoogle Scholar
  • 68 Vasile B, Rasulo F, Candiani A. et al. . The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome.  Intensive Care Med. 2003;  29 1417-1425
    CrossrefPubMedGoogle Scholar
  • 69 Zacharias M, Bridgman J, Parkinson R.. Two methods of administration of propofol for dental sedation.  Br J Oral Maxillofac Surg. 1998;  36 19-23
    CrossrefPubMedGoogle Scholar
  • 70 Zacharias M, Hunter KM, Parkinson R.. Respiratory effects of intravenous midazolam.  N Z Dent J. 1996;  92 76-79
    PubMedGoogle Scholar

Korrespondenzadresse:

PD Dr. Matthias Kreisler
Dr. Arda Yazici

Praxisklinik für Oralchirurgie und Implantologie Praxis für Anästhesie

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80331 München

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